Thromboelastography (TEG) offers a point-of-care and comprehensive evaluation of the coagulation cascade, but its utility in predicting bleeding risk in Interventional Pulmonology (IP) procedures has not been thoroughly investigated. This study aims to evaluate the effectiveness of TEG in assessing bleeding risk in patients undergoing elective IP procedures.

Retrospective study of patients who underwent elective IP procedures at Mayo Clinic (Jacksonville, FL, USA) from November 2022 to May 2024. Patients had TEG performed within a day before the procedure and met standard coagulation criteria (INR<2, platelets>50,000/mm³). The primary outcome was the incidence of bleeding, defined by validated scales. The association between TEG results and bleeding was analyzed using Fisher's Exact test and binary logistic regression.

76 patients were included, 13 (17.1 %) experienced bleeding despite “normal” coagulation panel. Of these, 10 (14.93 %) had a non-hypocoagulant TEG (p = 0.082) suggesting no statistical association of TEG results and bleeding. TEG showed high specificity (94 %) but low sensitivity (23 %) for predicting bleeding risk. Hypocoagulant TEG provided a 5.1-fold increase in the odds of bleeding in our study (OR 5.1, 95%CI: 0.84–31.29, p = 0.066). Notably, TEG results identified 8.9 % (n = 6) of patients as hypocoagulable and 50 % experienced bleeding, highlighting the potential value of TEG in identifying patients at higher risk.

TEG may offer additional value in pre-procedural bleeding risk assessment in IP procedures, particularly due to its high specificity. However, larger-scale studies are needed to confirm these findings and to better understand TEG's role in this context.